In their letter to the editor, Drs Lenzenweger and Pastore suggest using signal detection theory to assess pain thresholds in patients with BPD. For more than 20 years, it has been known that this approach is problematic for the assessment of pain thresholds.1 Signal detection theory relies on the correct or incorrect detection of sensory stimuli, which could lead to false-positive or negative results. However, in the investigation of pain, false-positive results are impossible since by definition pain relies on the subjective experience of an individual and is not based on an empirical parameter.2 This differentiates pain from nociception, which is related to the neural basis of pain processing.
Schmahl C, Bohus M, Esposito F, Treede R, Di Salle F, Greffrath W, Ludaescher P, Jochims A, Lieb K, Scheffler K, Hennig J, Seifritz E. On Determining Sensitivity to Pain in Borderline Personality Disorder—Reply. Arch Gen Psychiatry. 2007;64(6):748-749. doi:10.1001/archpsyc.64.6.748